Robert Laszewski is president of Health Policy and Strategy Associates, a policy and marketplace consulting firm that has him working closely with many in the heath industry as they try to navigate the Affordable Care Act, as well as the author of the excellent Health Care Policy and Marketplace Review blog. As such, he has a unique view on how the rollout looks from the industry side. We spoke on Wednesday. A lightly edited transcript of our conversation follows.

Ezra Klein: We last talked about 10 days ago. So in the interim, what are your insurance industry sources saying has changed on HealthCare.gov?

Bob Laszewski: Really nothing. There are two sides to this coin. The numbers of people enrolling and then the problems in processing enrollment information between federal government and insurance companies. If I were spinning for the White House I would say enrollment is up 50 percent! But thats because its up from like 10 a day to 15 a day. I havent talked to large insurers seeing more than 100 enrollments a day.

On the backdoor, the 834 connections, I had one client tell me they saw some improvement in the error rate, so I checked with three other clients, and they said they hadnt seen any improvement.

EK: So most people cant actually buy insurance through the Web site yet, and those who can may not be sending the right data to insurers?

BL: I almost have the sense that HealthCare.gov is in de facto shutdown. Heres why: Government has to fix the back end before the front end. The demand here is real. I dont think anyone can dispute that millions of people want to sign up...

I wonder why president stampyfoot felt it was better to throw $600 million away on a simple sign-up website that still doesn’t work rather than simply take what Mitt Romney implemented seven years and adapt it for national use.

3
posted on 10/23/2013 12:24:11 PM PDT
by muir_redwoods
(Don't fire until you see the blue of their helmets)

[Robert Laszewski, president of Health Policy and Strategy Associates, a policy and marketplace consulting firm]:The demand here is real. I dont think anyone can dispute that millions of people want to sign up...

So if they fix the front end for consumers and thousands of people or hundreds of thousands of people being enrolled before they fix the back end, well have a catastrophic mess.

Perfectly true. But the "back end" in this case isn't a database, it's the legislation itself. Here's an example:

This [834] process is decades old. Every union and every self-insured employer who contracts with an insurance company uses it. Its like a 74 Ford pick-up truck. Theres nothing complicated about it. People in the industry are shaking their heads over the errors theyre getting. Theyve been using this process for many years. No one has ever seen these kinds of errors before. No one has any idea where theyre coming from.

Here's a systems question so basic that every IT professional gets tired of hearing it: if it worked before, what changed? What served to change the relationships, the reporting, the established pipelines? The first place to look isn't the software, it's the underlying model. 0bamacare changed a very great deal of that. And by "changed" I mean "broke".

Not pretty and this is being put out by one of the most hardcore, MSNBC contributing, uber-lefties you can find. In essence by publishing the interview instead of reporting it, he is letting his source point out that the Administration has been lying about improvement.

Now they are just talking about the disastrous website. Wait until people get to sign up and are shocked by what happens next. People honestly think they were going to get free healthcare or free insurance.

It is working just like it is supposed to. The idea of a working website and affordable insurance is not the objective. Killing off private insurance and installing government controlled health care is where. this has always been headed. Creating this broken system to frustrate the unwashed just pushes it over the cliff faster. The founders would have already killed have the problem off all ready but we sheeple array just rolling over and letting the commies. win.

28
posted on 10/23/2013 3:33:27 PM PDT
by WilliamRobert
(Rafael Cruz is an American hero, and he makes me proud to be Texan.)

not necessarily. The article warns they will show up at the doctor thinking they are covered and he doesn’t know them. They get a notice they are insured but their supposed insuror doesn’t know them either.

Been in the web/marketing business for 14 years. That site (and everything that comes from it) was doomed the moment people began going to the site and saw all the errors, the lack of security, or couldn’t get through. Despite all the spin you may have heard, that alone killed it.

This administration (and their media court jesters) have this firm belief that unless they report it, it’s not news and therefore is not happening. That’s easy when something is happening out of your reach, or thousands of miles away. You can do your best to spin it to your liking.

The web world is a different medium all together. There is no media filter between you and a website. If it doesn’t work, you know it. I’ve heard the stories of people taking hours to get signed up. I doubt that. Ask yourself how long to you give a web site your visiting to work. According to anyone’s web stats, the average is usually measured in seconds, not hours.

They brag about all the sign ups, but won’t reveal (or let let insures reveal) the true sign up numbers. It’s like bragging about how many millions of people watch that show on your network last night - when the station was off the air the whole evening.

When the media really began reporting how bad the site was, my suspicions were that the sign ups had all but stopped at that point. the main story in the news cycle is how bad the site is, and you *really* think thousands are still trying to sign up? Get real.

And it goes beyond the site. As we say in the web world, ‘content is king’. No matter how good or bad your site is, if the content sucks, the site is doomed to failure anyway. In the case of this one, the prices being offered are not even close to being competitive to what’s in the marketplace. and forcing people to go to an overpriced product violates basic business laws. Regardless of how much power you think Washington has, they cannot force people to sign up on for a bad product on a site that doesn’t work, and my sources tell me the biggest problem they have with trying to fix the site, is that no decent programmers want to touch it (call it the John Galt Syndrome), or they want a King’s ransom to simply redo the whole thing.

The biggest issue is the whole rollout itself. The big box stores are getting ready for Black Friday and Cyber Monday right now. Beta testing and load testing is in progress. They plan to roll out on TV, print, radio and web - and a fraction of the costs. The government’s rollout consisted of some media hacks trying and failing to access the web site on national TV. It was pretty much doomed from that point.

In short, Ted Cruz et al has - as I predicted - been vindicated. If they don’t delay or scrap it altogether, the lawsuits will soon start after Jan 1 (when someone dies from losing their health insurance or the .gov site loses someone’s records), and some court(or state) *will* put a stop to it.

The Obama Recession

The ObamacareDisaster

Paper applications and the call center is the only reliable way for folks to sign up right now. And let me repeat...just to sign up. Then they have to wait for the paperwork to be sent back to them showing what plans they are eligible for, possible financial assistance, etc.

No one will benefit much at all unless they qualify for the tax credits giving them a lower monthly premium AND the cost reductions (which help lower the deductibles and co-pays).

Otherwise, you may have a low premium, but those deductibles will be very high.

The media has been boasting of the low premiums. But they need to let people know about those really high deductibles and co-pays. People need to be warned!

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